Active NPI
Jason Alan Zacks, MD
- Family Medicine Physician
- Dothan, AL
National Provider Identifier
1093710626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 24494
- Practice address
- 1920 Fairview Ave
Dothan, AL 36301-3008 - Phone
- (334) 678-1400
- Fax
- (334) 678-1432
- NPI assigned
- Jun 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 24494 | AL | Primary |
Addresses
Primary practice location
1920 Fairview Ave
Dothan, AL 36301-3008
Mailing address
1920 Fairview Ave
Dothan, AL 36301-3008
Phone (334) 678-1400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24494 | AL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason a. Zacks, MD PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Primary Care Clinic/Center
- Dothan, AL
- NPI 1619163078
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187222400000",
"number": "1093710626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1920 FAIRVIEW AVE",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363013008",
"telephone_number": "334-678-1400",
"fax_number": "334-678-1432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 FAIRVIEW AVE",
"city": "DOTHAN",
"state": "AL",
"postal_code": "363013008",
"telephone_number": "334-678-1400",
"fax_number": "334-678-1432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZACKS",
"first_name": "JASON",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-20",
"last_updated": "2007-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AL",
"license": "24494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dothan, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.